铁过载严重程度对非输血依赖型地中海贫血患儿血糖代谢的影响研究

Effect of iron overload severity on blood glucose metabolism in children with non transfusion dependent thalassemia

目的探讨铁过载严重程度对非输血依赖型地中海贫血(NTDT)患儿血糖代谢的影响。方法选取2019年1月~2021年6月收治的87例NTDT患儿为研究对象。所有患儿均行肝脏铁浓度核磁共振T2*检查,并根据检查结果进行铁过载严重程度分级。比较不同铁过载程度患儿糖代谢异常的发生率、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)以及胰岛素抵抗指数(HOMA-IR),并分析铁过载程度与FBG、HbA1c、FINS、HOMA-IR的相关性。结果经趋势卡方检验分析显示,不同铁过载程度患儿糖代谢异常的发生率比较差异有统计学意义(趋势χ^(2)=14.136,P<0.05),铁过载程度越严重,糖代谢异常的发生率越高。重度铁过载患儿FBG、FINS、HOMA-IR均高于正常、轻度、中度铁过载患儿,差异有统计学意义(P<0.05)。铁过载程度与FBG(r=0.531)、FINS(r=0.711)、HOMA-IR(r=0.830)呈正相关性(P<0.05),与HbA1c无明显相关性(P>0.05)。结论非输血依赖型地中海贫血患儿血糖代谢异常可能与铁过载导致的胰岛素抵抗有关,且铁过载程度越严重,患儿血糖代谢异常越明显。

Objective To explore the effect of iron overload severity on blood glucose metabolism in children with non transfusion dependent thalassemia(NTDT).Methods 87 children with NTDT treated in our hospital from January 2019 to June 2021 were selected as the research objects.All patients underwent MRI T2* examination of liver iron concentration,and the severity of iron overload was graded according to the examination results.The incidence of abnormal glucose metabolism,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),fasting insulin(FINS)and insulin resistance index(HOMA-IR)in patients with different degrees of iron overload were compared,and the correlation between iron overload and FBG,HbA1c,FINS and HOMA-IR was analyzed.Results The trend chi square test showed that the incidence of abnormal glucose metabolism in patients with different degrees of iron overload was statistically significant(trend χ^(2)=14.136,P<0.05).The more serious the iron overload,the higher the incidence of abnormal glucose metabolism.FBG,FINS and HOMA-IR in patients with severe iron overload were significantly higher than those in patients with normal,mild and moderate iron overload(P<0.05).The degree of iron overload was positively correlated with FBG(r=0.531),FINS(r=0.711)and HOMA-IR(r=0.830)(P<0.05),but not with HbA1c(P>0.05).Conclusion The abnormal blood glucose metabolism in children with NTDT may be related to insulin resistance caused by iron overload,and the more serious the iron overload,the more obvious the abnormal blood glucose metabolism.